Anthrax Anxiety May Be Worse Than Infection

Experts warn of long-term implications from bioterrorism threat

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HealthDay Reporter

THURSDAY, Oct. 18, 2001 (HealthDayNews) -- While the threat of catching anthrax may be real, the terror the threat has created may be more risky.

An international group of experts is raising concerns about the psychological impact of chemical and biological terrorism attacks, even if widespread contagion and death scenarios never materialize.

Scientists say the long-term implications of fear, confusion and uncertainty about the threat of attacks with agents such as anthrax may be worse than any physical effects.

In an editorial in the Oct. 20 issue of the British Medical Journal, a group of experts who've been studying the implications of biological or chemical threats in the United States or Britain write that there will be acute and long-term side effects.

The experts say, on the whole, chemical and biological weapons are unpredictable and ineffective as military weapons. "Anthrax, despite its dread reputation, is not a particularly good military weapon," says lead author Dr. Simon Wessely, a professor at the Institute of Psychiatry in London.

"But from a psychological perspective, it is causing a major impact, and it is, par excellence, a weapon of terror, of psychological warfare," says Wessely. "If that's the case, it does imply that the way in which we deal with it can either increase or decrease the effects."

Since the first cases of anthrax were reported, U.S. government officials have urged people to go about their daily business while at the same time warning of new terrorist attacks. While officials say they can handle a bioterrorist outbreak, at the same time they are working feverishly to increase a limited stock of vaccines and drugs to fight such illness. They vow that terrorists won't stop them, although one tainted letter led to an unprecedented shutdown of the House of Representatives.

Colleen Terriff, assistant professor of pharmacy practice at Washington State University in Spokane, Wash., says communities are struggling to cope with events that until recently seemed unthinkable, with fear of what lies ahead.

Terriff, who prepared a city contingency plan for a bioterrorism attack after an anthrax scare in Spokane, says the combination of media coverage, anthrax false alarms and hoaxes may desensitize people to anthrax anxiety. "You'd hate to have people let their guard down just because of an increased frequency of events," she says.

In the last week, TV reports of evacuations and unconfirmed sightings of white powdery substances have become commonplace. Wessely says the media can be most helpful by sticking to sober, factual reporting, while authorities can help by assessing the threat properly and acting accordingly.

He suggests some precautionary methods, such as the use of "space-suit" clad emergency workers, may increase the overall level of anxiety. Plans to install chemical weapons detectors at public sites around the United States, which Wessely says are likely to produce multiple false alarms, could make the situation worse.

"The way in which we respond to threats can sometimes exaggerate the threat," says Wessely. "The whole panoply of state and public health and FBI and police and fire brigades turn up, and this can increase the emotional temperature."

"If many of these incidents may be related to psychological distress, this is hardly the best way of managing them," he says.

Terriff says authorities do take psychological issues into account when they prepare for bioterrorism and chemical terror threats. For instance, she says chaplains and social workers played a role in the Spokane contingency plan.

She says people with pre-existing psychiatric disorders may be at greatest risk from terrorism anxiety. Touching on a point raised in the editorial, she says for people who are "severely depressed or have anxiety or are paranoid, I think a lot of these events could possibly tip these people over the edge. We have to take special care of that particular population and our children."

Wessely says public anxiety could stay high for years. Furthermore, it could raise the risk of mass "sociogenic" illness, such as the Sept. 29 incident at a Washington state middle school, where paint fumes triggered a bioterrorism scare that sent 16 students and a teacher to the hospital.

In an atmosphere of ongoing anxiety and confusion, Wessely says the public could ultimately lose trust in medical experts and the government. Without this trust, he says authorities would have increasing difficulty gaining control of situations.

And as highly-disputed topics such as Gulf War syndrome and exposure to depleted uranium in the Balkans suggest, he says unconfirmed or controversial theories about the health effects of exposure to chemical and biological weapons may become hot topics in science and the media for years after the threat subsides.

"I would be concerned that we don't get into a kind of cycle of conspiracy theory and Internet paranoia. If we do that, it will add to the impacts of these assaults on civil society," he says.

"In America, there has been one tragic death, and some people infected, but it's not the end of the world. There's no reason to believe that this will bring civil society to its knees -- unless we let it," says Wessely.

What To Do: Get tips on how to deal with the stress resulting from the aftermath of the Sept. 11 attacks from the American Psychological Association, the Association of Traumatic Stress Specialists or the National Center for Post-Traumatic Stress Disorder.

SOURCES: Interviews with Simon Wessely, M.D., professor, head, section of general hospital psychiatry, division of psychological medicine, Guy's, King's and St. Thomas' School of Medicine and the Institute of Psychiatry, London, and Colleen M. Terriff, Pharm.D., assistant professor, Department of Pharmacy Practice, Washington State University, Spokane; Oct. 20, 2001, British Medical Journal

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