MONDAY, March 17, 2003 (HealthDayNews) -- It's a nightmare scenario that would have been unthinkable in the pre-9/11 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 this week's 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's 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 U.S. 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 U.S. Centers of Disease Control and Prevention, which has a program with the Federal Bureau of Investigation 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:
- 95 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.
- 60 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.
More information
You can learn more about anthrax, its symptoms and treatment from the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.
