Parker Waichman LLP Injury Alerts
BIOTERRORISM - A New Worry in an Already Complicated WorldJan 1, 2002 Before September 11th, most Americans knew very little about anthrax. Now, they probably wish they did not know as much as they do. In the past three months, the possibility of an accidental or intentional release of an biological or chemical agents on an unsuspecting public has gone from the type of crisis you would have expected to encounter in the plot of a summer blockbuster or the latest science fiction novel rather than in a trip to your own mailbox.
Today, bioterrorism is on everyone's mind regardless of their age, occupation or where they live. Unfortunately, this concern has brought with it a number of issues which many people are finding difficult to deal with. These include:
(1) Information "overload".
(2) Fear and anxiety.
(3) Confusion concerning protection.
(4) Unscrupulous merchants peddling questionable or worthless anti-terrorism products.
In order to assist our subscribers in dealing with the troublesome issues, we have reviewed hundreds of news articles, web sites, scientific publications, televised reports and government warnings. The result is this summary of vital information regarding all aspects of the bioterror threat. We hope that it will help educate our readers in a way that will ease their anxiety, protect them from unscrupulous merchants and give them a better understanding of the nature and extent of the dangers they face.
I. BIOTERRORISM - Understanding the risk.
The use of biological and chemical weapons dates back thousands of years. The historical record indicates that man has always had the desire and capacity to create weapons that would injure or kill faster, more effectively and in greater numbers. Thus, arrows, spears and darts tipped with poisons ranging from plant extracts to human feces have been in widespread use throughout the world for longer than most people imagine. Other "early" forms of bioterrorism include poisoning an enemy's water supply and infecting his livestock or grain with disease causing bacteria.
Even the simplest of biological or chemical weapons can cause enormous damage. Petroleum products like gasoline, motor oil and diesel fuel can contaminate drinking water and soil used for agriculture while sharp sticks dipped in human waste can cause horrendous wounds and deadly infections.
Until World War I, however, there had been an unwritten agreement between the major military powers to refrain from the use of biological and chemical weapons. Unfortunately, during that conflict, the use of poison gas by the Germans was the catalyst for a biological and chemical weapons race that continues until today.
Although the Nazis utilized carbon monoxide and other gases to murder millions of innocent people during World War II, there was very little use of biological or chemical agents on the battlefields of Europe. The Japanese, on the other hand, developed an extensive, top secret chemical and biological weapons program headquartered in Manchuria where a large number of horrific experiments were conducted on human subjects as well as Chinese civilian targets. Following the war, very little information about this program leaked out to the public as both the Americans and Russians sought to keep the whole matter a secret while they each attempted to obtain as much of the technology as possible from captured scientists and documents.
During the "Cold War", the United States and the Soviet Union continued to develop and stockpile enormous quantities of chemical and biological weapons. Despite efforts to curtail their production through a series of agreements, mutual distrust made it virtually impossible for either nation to make a real effort to put an end to the madness until the mid-1970s. By them, however, the genie had been out of the bottle for so long that it was no longer possible to hope for these weapons of mass destruction to be abolished. The technology and world-wide unrest had reached a level where even the smallest countries or most radical fringe groups wanted, and could obtain, what they believed was an "equalizer" in their efforts to stand up to the world's super powers or to give themselves instant credibility.
Although recent events cannot help but to raise the level of anxiety among members of the general public, a number of other factors should be considered. For example, most truly dangerous chemical and biological weapons require sophisticated delivery systems to make them a significant threat. Most countries and terrorist groups simply do not have the capability to deliver the substances in a way that would maximize their effectiveness. The lack of technological skill and laboratory facilities also makes it more difficult for most terrorists to develop or refine these weapons to the point where they pose more than a modest threat.
In addition, chemical agents are less dangerous than most people believe. They are only truly effective in closed or confined spaces since they disperse quickly in open areas and dispersal destroys their effectiveness. Chemical agents (unlike biological ones) do not reproduce and many of them decompose quickly because they are relatively unstable.
On the other hand, there are some important negatives one must contend with when it comes to biochemical agents. The first is that by the time you know or even suspect a biochemical attack has started, it is too late to avoid the consequences of exposure. thus, unless you wear a mask and other protective equipment all of the time, you will not escape the effects of direct biochemical exposure. Moreover, biochemical agents are more than capable of being absorbed through the skin. Consequently, only extremely expensive and sophisticated masks and clothing (HAZMAT suits, for example) offer complete protection.
Finally, it must be remembered that the decaying stockpile of biochemical weapons in the United States and throughout the former Soviet Union present a very real threat of accidental release or criminal seizure. The accidental release of anthrax at a Soviet production site in 1979 killed almost one hundred people. Today, the poor economic conditions in the former Soviet Union also raise the possibility of unemployed scientists selling their services to rogue nations or terrorist groups.
Biochemical agents have also progressed quite a bit since the primitive, although still effective, weapons of the 1940s and 1950s. Today, advanced technological capabilities make it likely that a new generation of "bioregulators" is close to becoming a reality. Bioregulators are agents which can significantly alter or disrupt heart and sleep patters as well as moods. Such weapons would only serve to make an already bad situation worse.
A. Facts about anthrax (reprinted with permission of the Centers for Disease Control and Prevention):
Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in hoofed mammals and can also infect humans.
Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days after exposure. The serious forms of human anthrax are inhalation anthrax, cutaneous anthrax and intestinal anthrax.
Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms progress to severe breathing problems and shock. Inhalation anthrax is often fatal.
The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial sings of nausea, loss of appetite, vomiting and fever are followed by abdominal pain, vomiting of blood and severe diarrhea.
Cutaneous (skin) anthrax accounts for 95% of all cases. This is the least serious form of the disease and begins with a swollen area on the skin -- similar to a large insect bite. Over several days, the swelling increases and eventually a black scab forms in the center of the affected area. Cutaneous anthrax often causes fever and headaches.
Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. Therefore, there is no need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends or coworkers, unless they also were exposed to the same source of infection.
In persons exposed to anthrax, infection can be prevented with antibiotic treatment. Early antibiotic treatment of anthrax is essential -- delay lessens chances for survival. Anthrax usually is susceptible to penicillin, doxycycline and fluoroquinolones.
An anthrax vaccine also can prevent infection. Vaccination against anthrax is not recommended for the general public to prevent disease and is not available.
B. Miscellaneous Medical Issues
1. A runny nose, which is a common symptom of the flu and other respiratory viruses, is not one of the usual symptoms of anthrax.
2. Antibiotics do not afford protection against contracting anthrax in the future.
3. Surface decontamination can be accomplished by the use of soap and water followed by a mixture of one-part household bleach to ten-parts water. The area should be rinsed after 10 to 15 minutes. Technical assistance is available from the National Response Center at 1-800-424-8802.
4. Severe breathing problems are a symptom of the often fatal inhaled form of anthrax. In the event of such symptoms (with or without the flue), seek immediate medical attention.
5. Influenza poses a much more serious threat to the public health than anthrax. Very few people contract anthrax and even fewer die as a result of the disease. On the other hand, 25 million to 50 millions cases of the flu occur each year and some 20,000 deaths are caused from complications.
6. Studies indicate that a dose of 2,500 to 55,000 spores is lethal in about 50% of the cases of inhaled anthrax.
7. The Centers for Disease Control and Prevention, the American Medical Association and the National Institute of Allergies and Infectious Diseases (NIAID) have advised doctors and medical facilities such as hospital emergency rooms to remain alert for patients exhibiting symptoms of anthrax infections or other illnesses caused by biological or chemical agents.
8. No conclusive medical evidence exists to support claims that the anthrax vaccine has caused a number of adverse reactions among female members of the military. The vaccine, which is not currently available to the public, has always been considered safe after some 18 studies done by various testing organizations.
C. Dealing with the threat:
Although it is extremely unlikely that any individual will ever come into contact with anthrax, there are some common sense suggestions that you can follow to lessen those chances even further.
1. Be aware of what anthrax looks like. A brownish, grainy substance in most crude preparations. A sophisticated laboratory could produce a fine white powder, however.
2. Do not open unusual or suspicious packages or letters -- report them to the appropriate authorities.
3. Do not tear open envelopes or packages. Carefully open all mail to avoid dispersing any anthrax spores which might have attached themselves to a piece of mail by cross-contamination.
4. Save any envelope or package which may have contained any suspicious substance.
5. Learn to identify suspicious pieces of mail by looking for the following:
a. No return address.
b. Misspelled words or incorrect titles.
c. Unknown persons on return address.
d. Excessive postage.
e. Restrictive directions such as "personal", "confidential", etc.
f. Lopsided or bulky.
g. Strange odor.
h. Badly typed or written.
i. Addressed to a title only such as "President", "Manager", "Security", etc.
j. Excessive wrapping, tape or string.
k. Oily stains, discolorations or crystalizations on wrapper.
l. Powdery substances inside the package.
A. Facts about Smallpox. (reprinted with permission of the Centers for Disease Control and Prevention):
Smallpox was eliminated from the world in 1977.
Smallpox is caused by variola virus. The incubation period is about 12 days (range: 7 to 17 days) following exposure. Initial symptoms include high fever, fatigue, and head and back aches. A characteristic rash, most prominent on the face, arms and legs, follows in 2-3 days. The rash starts with flat red lesions that evolve at the same rate. Lesions become pus-filled and begin to crust early in the second week. Scabs develop and then separate and fall off after about 3-4 weeks. The majority of patients with smallpox recover, but death occurs in up to 30% of the cases.
Smallpox is spread from one person to another by infected saliva droplets that expose a susceptible persons having face-to-face contact with the ill person. Persons with smallpox are most infectious during the first week of illness, because that is when the largest amount of virus is present in saliva. However, some risk of transmission lasts until al scabs have fallen off.
Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; these persons are assumed to be susceptible.
Vaccination against smallpox is not recommended to prevent the disease in the general public and therefore is not available.
In people exposed to smallpox, the vaccine can lessen the severity or even prevent illness if given within 4 days after exposure. Vaccine against smallpox contains another live virus called vaccinia. The vaccine does not contain smallpox virus.
The United States currently has an emergency supply of smallpox vaccine.
There is no proven treatment for smallpox but research to evaluate new antiviral agents is ongoing. Patients with smallpox can benefit from supportive therapy (intravenous fluids, medicine to control fever or pain, etc.) and antibiotics for any secondary bacterial infections that occur.
B. Related Information:
1. A new anti-viral drug may be effective against smallpox, and, although not yet tested in clinical trials, would probably be used in an epidemic.
2. In past epidemics, the mortality rate has been about 30% where there has been a general supportive medical response.
3. The British distributed smallpox tainted blankets to "disaffected tribes of native Americans between 1754 and 1767.
4. Smallpox is a "low-tech" weapon since you do not need a sophisticated dispersal system to cause of widespread health crisis. All that is needed is infected people which would be "the biological equivalent of a suicide bomber", according to Dr. Raymond Zilinskas, the Deputy Director of the Chemical and Biological Weapons Nonproliferation Program.
5. The high mortality rate and long incubation period make smallpox a potentially greater risk that most other biological weapons.
6. People immunized before 1971 may or may not still be protected. There is some debate over this with some medical experts claiming that those who received multiple shots of smallpox vaccine (three) could still fight the disease quite effectively. Thus, even though immunity decreases considerably after 20 years, a fully immunized person would have a far less chance of dying if he or she did contract the disease. (Research from the early 1900s indicates a 10% mortality rate in people vaccinated as much as 50 years before).
7 Because of heightened awareness, any smallpox outbreak would be recognized quickly thereby allowing for prompt vaccination (within the 11 day incubation period) of those who may have come in contact with any victim.
IV. PNEUMONIC PLAGUE
Facts about pneumonic plague (reprinted with permission of the Centers for Disease Control and Prevention):
Plague is an infectious disease of animals and humans caused by the bacterium Yersinia pestis. Y. pestis is found in rodents and their fleas in many areas of the world.
Pneumonic plague occurs and Y. pestis infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness and cough productive of bloody or watery sputum. The pneumonia progresses over 2 to 4 days and may cause septic shock and, without early treatment, death.
Person-to-person transmission of pneumonic plague occurs through respiratory droplets, which can only infect those who have face-to-face contact with the ill patient.
Early treatment of pneumonic plague is essential. Several antibiotics are effective, including streptomycin, tetracycline and chloramphenicol.
There is no vaccine against plague.
Prophylactic antibiotic treatment for 7 days will protect persons who have had face-to-face contact within infected patients.