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Biological Agents

What You Don't Know Can Kill You

In June of 1999 a CDC panel of experts in medicine, public health, military intelligence and law enforcement evaluated the biological agents listed below and ranked them according to a matrix analysis.

Category A contains agents that were considered the greatest threat in terms of causing casualties and in terms of the need for stockpiling antibiotics and vaccines.

Category B agents were considered to have potential for transmission and illness, but with fewer requirements for public health action.

Category C agents were those considered as possible emerging public health threats.
 

SMALLPOX

Smallpox, the nightmare to end all nightmares that was eliminated as a natural disease in the 1970s, often starts with a simple fever—the sort of thing anyone might get. The disease has a relatively long incubation period (the time from exposure to first symptoms). If you were unlucky enough to be exposed to the virus, it would take about twelve days for those first signs of fever, headache, and malaise to appear. Next a red rash will appear in your mouth, throat, and on the face; soon after that it appears on the arms, legs, and torso. At first the rash doesn’t look like much and can be mistaken for chickenpox. A trained health care worker could detect important differences, but it takes a special kind of person — the kind who, when the sound of galloping horses nears, considers that it might possibly be a herd of zebras. Soon the horror begins. The pocks bullet-like, pus-filled blisters — begin to appear on the skin. As you enter this stage, you’re likely in agony; people have compared it to having their skin on fire. At this point, you’ve been highly infectious for several days, and for another week your body will keep pumping out virus particles with every breath, infecting your loved ones, your doctors, and anyone else unfortunate enough to come near. Only after several days of rash and the appearance of pocks is a physician likely to consider smallpox. Even then, that will probably only happen if the doctor is old enough to have seen it or has had sufficient training in biological agents.

The disease is caused by the variola virus. It is a naturally occurring disease that spreads from person to person through airborne respiratory droplets, or aerosols. If you’re thinking you’re immune, you’re probably mistaken. Vaccinations ceased in the l970s, so today’s under-thirty population has no immunity; what’s worse, many of the people who were vaccinated thirty or more years ago have lost or reduced their immunity as their vaccinations wore off. That leaves you unprotected, or with limited protection, against a disease that kills one in three victims. And if you do recover, you’ll bear the disfiguring pockmark scars for the rest of your days. There is no cure for smallpox; although the chance of survival in a limited number of cases could possibly be improved by a currently available antiviral drug, it is difficult to use and in short supply. Few people in the world can even remember smallpox: it’s been more than fifty years since the last case occurred in the United States, and the last naturally occurring case in the world was reported in Somalia in October 1977. Since that time, it has been assumed that mankind’s worst scourge was over.  However, with the revelations that Russia, Iraq, and North Korea harbor undeclared stocks of smallpox virus, we must once again consider the possibility of its return. To put smallpox into perspective, one only need look at what disease and death it caused throughout the world in the twentieth century. The world’s population was much smaller, of course, through most of this century— 1.6 billion people in 1900, compared to 6 billion in 1999—and smallpox was substantially reduced in most of the developed world by the 1940s. Still, despite its relative rarity through much of the century in so many areas of the world, approximately 500 million people died of smallpox in the century that just ended. This compares with 320 million deaths during the same period as a result of all military and civilian casualties of war, cases of swine flu during the ruinous 1918 pandemic, and all cases of AIDS worldwide. These staggering numbers make painfully clear how grave a global crisis any return of smallpox would represent; the use of it as a weapon would constitute the ultimate crime against humanity.

If a case of smallpox were actually identified, everyone who had come in contact with that patient would have to be vaccinated immediately to reduce the risk of additional cases. But as we will see in later chapters, the supplies of vaccine have dwindled to 15.4 million doses in the United States inventory, which is held by the CDC. Of note, the CDC has come up with the 15.4 million estimate; other experts seriously doubt if we could get 7 to 8 million doses out of our current stockpile. Either number may seem like a lot of doses, but the number is deceptive: during a relatively small 1972 outbreak in Yugoslavia, that nation of 21 million people required 18 million doses of the vaccine in only ten days.

Currently, the smallpox vaccine in our inventory as well as around the world is primarily derived from the old process of scarification of calves — scratching the virus vaccinia (not smallpox, but cowpox) into the skin of a calf and harvesting the subsequent infection. Most of our severely limited vaccine supply is more than twenty-five years old. For safety reasons, we can no longer use a live cow-pox vaccine, which is essentially “cleaned up” cow pus. Even though in early 2000 the federal government has finally initiated activities to develop and produce a new vaccine from cell cultures, it will be years before new and sufficient vaccine is available. If an actual release of smallpox (whether intentionally or by accident) were to lead to an epidemic, only early detection, isolation of the infected individuals, surveillance of their contacts, and a focused selective vaccination program wi11 allow us to regain control.

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ANTHRAX

Anthrax is a brilliantly efficient killer. Most people who come by the disease naturally have been exposed to infected animals — eating contaminated meat or handling the skins or wool of infected animals. The bacteria can enter the body through ingestion — that is, eating the contaminated meat — or through contact with broken skin, which develops into what is called wool-sorter’s disease. When it enters through the skin, antibiotics are often sufficient to bring about a full recovery.

Breathing the bacteria into your lungs, however, causes a different form of the disease: inhalational anthrax.  This is the most deadly form, and the most likely one that a terrorist would try to exploit. If you breathed the spores into your lungs, you would probably be ill within two to ten days — but your body could hold off showing signs of illness for the next six to seven weeks. ‘When it does hit you, it’s swift and ruthless. As the bacteria grow in the lymph nodes of your chest, early symptoms mimic many common flu like illnesses. By the time you’ve got a full-blown case and get a proper diagnosis, antibiotics and intensive medical care are unlikely to help. If you’re like most patients, you’ll be dead within twenty-four to seventy-two hours from overwhelming infection and shock caused by toxins that the bacterium produces.

There is substantial evidence that antibiotic treatment and use of anthrax vaccine after exposure but before symptoms can greatly reduce both the number of illnesses and the number of deaths. This creates other problems, however, since a bioterrorism release will likely involve far more people than our current supplies of both could help. If there is any good news about anthrax at all, it’s that there is no evidence that the disease can be passed from person to person. Still, Bacillus anthracis, the agent that causes anthrax, is the most serious of the bacterial threats that we face because it is the likeliest one to be used. Easier to get and grow than smallpox, it is the biological agent that the Soviets, the Iraqis, and even the United States (in the 1960s) gave a high priority to for “weaponization,” or turning into a weapon.

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PLAGUE

As its historical name implies, plague is a disease that has evoked panic and fear in populations dating back to our earliest history. People usually contract the disease, caused by Yersinia Pestis, after being bitten by an infected flea. The bite leads to bubonic plague, with distinctly swollen and painful lymph nodes —the “buboes” that give the disease its name. Appropriate and timely treatment with antibiotics can cure this form of the disease. Those who have developed biological weapons, however, have generally chosen a more direct and potent route: inhaled aerosol.

One to six days after you breathe in the microbe, you are likely to develop the especially virulent form, pneumonic plague. If you don’t get treatment, you will quickly slide into kidney and respiratory failure and subsequent shock followed most likely by death. Although there is no available vaccine for plague, rapid use of antibiotics for those likely to have been exposed to the aerosol of plague or to cases of pneumonic plague is crucial. As with anthrax, the difficulty of getting adequate supplies of antibiotics to the victims in time to help them is daunting. Unlike anthrax, however, plague has been shown to pass from person to person. It’s not nearly as contagious as smallpox, but an attack would certainly affect more people than those caught up in the initial exposure.

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BOTULINUM TOXIN

Botulism is typically a food borne ailment caused by the toxins of Clostridium Botulinum. Ingesting the tiniest amounts usually leads, twenty-four to thirty-six hours later, to blurred vision and difficulty in swallowing and speaking. Depending on the severity of exposure — and ingesting minuscule amounts of the toxin can have direct results — the symptoms may progress to general weakness, respiratory failure, and death.

In a large outbreak, all you can hope for is that your community has enough respirators available to keep you alive when your own useless muscles can’t do the breathing for you. Of course, that’s not the case in any city in the United States today.

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TULAREMIA

There are a few forms of the bacterial disease tularemia, but the only one likely to be used as a weapon is the inhaled, or typhoidal, variety. It causes you to develop fever, chills, headache, and general weakness, as well as chest pain, weight loss, and a nonproductive cough. It kills an estimated 35 percent of its victims.  The effects come on quite quickly, usually within three to five days. An especially hardy bug — it resists freezing and can remain viable for weeks in water — tularemia was cultivated for weapons use by the United States in the 1950s and 1960s, by the Soviet Union, and by other nations as well. It can be treated with certain antibiotics. However, as with the case of an outbreak of anthrax or plague, if you came down with tularemia you would desperately need antibiotics — and supplies of those drugs aren’t adequate to ward off the effects of a large-scale attack.

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HEMORRHAGIC FEVERS

Hemorrhagic fevers are the horrifying diseases described in books like Richard Preston’s The Hot Zone: ailments that cause the body’s fluids to leak out of tissues and orifices and cause particularly gruesome deaths. These viruses kill an estimated 30 to 90 percent of their victims. The most famous of these, the filovirus Ebola, has been known since 1976 but has never been seen in the United States. Its effects come on fairly quickly, usually within three to five days. It can be treated with some antiviral drugs —which, however, like key antibiotics, aren’t available in large amounts.

Members of the Aum Shinrikyo cult flew to Zaire in hopes of finding samples to turn into biological weapons. They apparently were unsuccessful in finding the elusive virus. Another viral hemorrhagic fever, Marburg has been associated with an outbreak in Germany and Yugoslavia that infected thirty-one people. According to former Soviet bioweapons official Kenneth Alibek, the Soviets tested Marburg extensively and based their weapon version on a strain that killed a scientist in a laboratory accident. The category also includes yellow fever, Lassa fever, dengue, and more. Some of these diseases respond to antiviral drugs, but these drugs are in short supply and would not be available for large populations of victims.

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All excerpts taken from Living Terrors (What America Needs To Know...) by Micheal Osterholm, & John Schwartz.

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